Surgical Management of Giant Left Sinus of Valsalva Aneurysm Causing Left Anterior Descending Coronary Artery Occlusion Zhaolei Jiang, MD, PhD, Min Tang,

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Surgical Management of Giant Left Sinus of Valsalva Aneurysm Causing Left Anterior Descending Coronary Artery Occlusion Zhaolei Jiang, MD, PhD, Min Tang, MD, PhD, Hao Liu, MD, PhD, Ju Mei, MD, PhD The Annals of Thoracic Surgery Volume 104, Issue 1, Pages e27-e29 (July 2017) DOI: 10.1016/j.athoracsur.2017.01.099 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Preoperative and follow-up transthoracic echocardiographic views. (A) Preoperative view showing a giant left sinus of Valsalva aneurysm (SVA). An aorta orifice was found between the aorta and the SVA. A few mural thrombi were monitored in the SVA. (B) Follow-up view showing complete closure of aortic orifice with patch, and thrombosis in the whole SVA. (AAO = ascending aorta) The Annals of Thoracic Surgery 2017 104, e27-e29DOI: (10.1016/j.athoracsur.2017.01.099) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative and follow-up computed tomographic (CT) views. (A) Preoperative view showing giant left sinus of Valsalva aneurysm (SVA), 55.0 mm × 66.8 mm. (B) Follow-up view showing complete closure of aortic orifice with patch. (RA, LP and A, L, H, F represent the direction of the heart.) (C) Preoperative view showing occlusion of left anterior descending (LAD) caused by external compression of giant SVA. (D) Follow-up view showing single bypass graft with saphenous vein (SV) connecting the ascending aorta (AAO) to the middle portion of the LAD artery. LAD revascularization was satisfactory. (A = anterior; F = foot; H = head; L = left; LCX = left circumflex; LP = left posterior; RA = right anterior; VA = ventricular aneurysm.) The Annals of Thoracic Surgery 2017 104, e27-e29DOI: (10.1016/j.athoracsur.2017.01.099) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Intraoperative images. (A) The aorta orifice of the sinus of Valsalva aneurysm (SVA) was found after the ascending aorta (AAO) was opened. (B) The aorta orifice of the SVA was completely repaired with bovine pericardial patch. (C) The coarctation site of the anterior wall of AAO was widened with autologous pericardium. A single bypass graft with saphenous vein (SV) connecting AAO to the middle portion of the left anterior descending artery was constructed. The Annals of Thoracic Surgery 2017 104, e27-e29DOI: (10.1016/j.athoracsur.2017.01.099) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions